Arquivos Brasileiros De Oftalmologia[JOURNAL]
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200 papers
Intravitreal dexamethasone sodium phosphate challenge to predict implant response in refractory diabetic macular edema: a pilot study.
Lira RPC, Paiva MMTF, Lira GR … +1 more , Gaete MIL
Arq Bras Oftalmol · 2026 · PMID 42207107 · Publisher ↗
PURPOSE: To evaluate the accuracy of a short-term intravitreal dexamethasone sodium phosphate challenge in predicting the anatomical response to a sustained-release dexamethasone implant (Ozurdex) in patients with refrac...
PURPOSE: To evaluate the accuracy of a short-term intravitreal dexamethasone sodium phosphate challenge in predicting the anatomical response to a sustained-release dexamethasone implant (Ozurdex) in patients with refractory diabetic macular edema. METHODS: This prospective, non-randomized, Phase 2 pilot study enrolled 12 pseudophakic eyes with diabetic macular edema refractory to anti-vascular endothelial growth factor (anti-VEGF) therapy. Participants underwent a challenge phase (Day 0) consisting of a single intravitreal injection of 0.08-mg dexamethasone sodium phosphate, followed by a maintenance phase (Day 7), during which all subjects received a 0.7-mg dexamethasone implant. The primary outcome was concordance between the anatomical response at Day 3 (post-dexamethasone sodium phosphate) and Day 60 (post-implant), defined as a ≥10% reduction in central macular thickness. Secondary outcomes included achieving a clinically "dry" macula (central macular thickness ≤300 μm) at Day 60, changes in best-corrected visual acuity, safety outcomes (intraocular pressure), and spectral-domain optical coherence tomography biomarker analysis. RESULTS: The dexamethasone sodium phosphate challenge induced significant macular drying by Day 3 (median central macular thickness reduction, -21 μm; p=0.002). A positive response to dexamethasone sodium phosphate strongly predicted response to the dexamethasone implant, with a positive predictive value and specificity of 100%. The negative predictive value was 80%. Irreversible biomarkers, including disorganization of retinal inner layers and ellipsoid zone disruption, were more prevalent among nonresponders (60% vs. 28.6%). Safety outcomes were acceptable; 16.7% of patients developed ocular hypertension, which was successfully managed with topical therapy. CONCLUSION: A short-term dexamethasone sodium phosphate challenge is a safe, low-cost, and highly specific predictor of dexamethasone implant efficacy. This "test-and-treat" strategy may optimize resource allocation in resource-constrained settings by identifying responders before high-cost implantation.
Presumed ocular histoplasmosis syndrome phenocopy in Brazil.
Couto AP, Japiassú R, Vianna RNG
Arq Bras Oftalmol · 2026 · PMID 42207106 · Publisher ↗
Abstract loading — click title to view on PubMed.
Eyebrow and eyelid position in anophthalmic sockets reconstructed with conical or spherical implants: a quantitative analysis.
Bigheti CP, Sousa RLF, Brandão SM … +2 more , Padovani CR, Schellini SA
Arq Bras Oftalmol · 2026 · PMID 42207105 · Publisher ↗
PURPOSE: To quantitatively compare eyebrow and eyelid positions in anophthalmic sockets reconstructed with conical or spherical orbital implants combined with customized external ocular prostheses. METHODS: This cross-se...
PURPOSE: To quantitatively compare eyebrow and eyelid positions in anophthalmic sockets reconstructed with conical or spherical orbital implants combined with customized external ocular prostheses. METHODS: This cross-sectional observational study included 38 patients with unilateral anophthalmic sockets, of whom 21 received conical implants, and 17 received spherical implants. Eyelid and eyebrow parameters-including margin reflex distance 1 and 2, vertical and horizontal palpebral fissure dimensions, eyebrow-to-upper-eyelid margin distance in primary gaze and infraduction, medial and lateral eyelid angles in primary gaze, and superior eyelid sulcus depth -were quantitatively assessed using standardized digital photographs analyzed with Image J software. The contralateral healthy eye served as the control. Statistical analyses were performed to compare measurements between groups. RESULTS: In the primary gaze position, conical and spherical implants showed comparable margin-reflex distance1, margin-reflex distance2, vertical palpebral fissure height, eyelid margin position, and medial and lateral eyelid angles. During infraduction, the upper eyelid margin was significantly lower in sockets reconstructed with conical implants. Compared with contralateral normal eyes, anophthalmic sockets exhibited a reduced horizontal palpebral fissure and a deeper superior eyelid sulcus, irrespective of implant shape. CONCLUSION: Anophthalmic sockets reconstructed with conical or spherical implants demonstrate similar eyebrow and eyelid positioning in primary gaze. However, conical implants are associated with a lower eyelid margin during infraduction. Independent of implant format, anophthalmic sockets show a narrower horizontal palpebral fissure and increased superior sulcus depth compared with normal eyes.
Corneal sensitivity recovery after phacoemulsification: quantitative esthesiometric analysis.
Marques IPG, Hilgert CVR, Oliani CHP … +4 more , Contrera JC, Colombo-Barboza MN, Colombo-Barboza GN, Moscovici BK
Arq Bras Oftalmol · 2026 · PMID 42207104 · Publisher ↗
PURPOSE: To quantitatively assess changes in central corneal sensitivity after phacoemulsification and to characterize recovery patterns up to 90 days using standardized esthesiometry. METHODS: This prospective observati...
PURPOSE: To quantitatively assess changes in central corneal sensitivity after phacoemulsification and to characterize recovery patterns up to 90 days using standardized esthesiometry. METHODS: This prospective observational study included 44 patients (88 eyes) undergoing uncomplicated phacoemulsification with intraocular lens implantation. Central corneal sensitivity was measured using a Cochet-Bonnet® esthesiometer preoperatively and at 30 and 90 days postoperatively. Repeated-measures data were analyzed using Friedman and Wilcoxon signed-rank tests (p<0.05). Inter-eye differences were assessed with a paired Wilcoxon test. Individual changes from baseline (∆30, ∆90) were calculated, and 90-day recovery was categorized according to thresholds aligned with the 5-mm device resolution. Spearman correlation was used to explore associations between age and ∆90. RESULTS: Corneal sensitivity decreased after surgery. In right eyes, mean sensitivity declined from 41.14 ± 7.77 mm at baseline to 36.82 ± 9.03 mm at 30 days and partially recovered to 38.64 ± 7.73 mm at 90 days. In left eyes, sensitivity decreased from 44.11 ± 6.29 mm to 37.39 ± 9.05 mm at 30 days and recovered to 41.82 ± 7.63 mm at 90 days. Left eyes showed higher sensitivity than right eyes at baseline (p=0.023) and at 90 days (p=0.018). At 90 days, complete or near-complete recovery (within ± 5 mm of baseline) occurred in 73.2% of right eyes and 78.0% of left eyes, while improvement above baseline (≥ +5 mm) occurred in 7.3% and 4.9%, respectively. Age showed weak, nonsignificant correlations with ∆90 (p=-0.14 to -0.19; p>0.2). CONCLUSION: Phacoemulsification with a 2.75-mm clear corneal incision leads to a temporary reduction in central corneal sensitivity, with partial recovery by 90 days. Recovery patterns vary among individuals, highlighting the value of postoperative sensitivity monitoring to identify atypical trajectories and guide ocular surface care during visual rehabilitation.
Musculoskeletal disorders in ophthalmologists and ophthalmology residents in Brazil.
Nogueira JTDS, Araújo TMC, Cunha CEXD … +3 more , Cipriano CHA, Ventura CV, Santos MB
Arq Bras Oftalmol · 2026 · PMID 42207103 · Publisher ↗
PURPOSE: To assess musculoskeletal symptoms, identify the most affected body areas, and investigate factors associated with the development of musculoskeletal disorders among ophthalmologists in Brazil. METHODS: A survey...
PURPOSE: To assess musculoskeletal symptoms, identify the most affected body areas, and investigate factors associated with the development of musculoskeletal disorders among ophthalmologists in Brazil. METHODS: A survey was conducted using an online questionnaire and snowball sampling. Statistical analyses were performed using Jamovi version 2.3.28, and graphs were generated using RStudio version 2023.06.2 + 561. RESULTS: A total of 233 participants (42 ophthalmology residents and 191 ophthalmologists) were included, with a mean age of 40.4 years (standard deviation 11.3; range 25-73 years). Musculoskeletal symptoms were reported by 83% of participants. The cervical region (57.1%), upper back (54.5%), and lumbar region (53.6%) were the most frequently reported sites of pain. A high body mass index was identified in 54.9% of the sample, and 50.2% of participants reported using painkillers in the previous year for musculoskeletal symptoms. The mean duration of professional activity in ophthalmology was 13.5 years, and the mean weekly workload was 39 hours. A significant association was observed between weekly workload and the presence of musculoskeletal disorders (p=0.045). CONCLUSION: This study demonstrated a high prevalence of musculoskeletal disorders among ophthalmologists in Brazil, particularly involving the cervical, lumbar, and upper back regions, consistent with findings reported in international studies. Important contributing factors include long working hours, a high patient volume, and repetitive or awkward postures during examinations and procedures. Preventive strategies and improvements in working conditions are needed to protect the health and well-being of ophthalmologists.
Reliability of a Scheimpflug-based tomographer compared with a Placido-based topographer and specular microscopy in healthy eyes.
Budib CL, Oliani CHP, Ferreira GO … +6 more , Tachibana U, Gomes JÁP, Moscovici BK, Colombo-Barboza LR, Colombo-Barboza MN, Colombo-Barboza GN
Arq Bras Oftalmol · 2026 · PMID 42207102 · Publisher ↗
PURPOSE: To evaluate the reliability and comparability of a Scheimpflug-based tomographer relative to a Placido-based topographer and specular microscopy in healthy eyes. METHODS: This cross-sectional study included 40 p...
PURPOSE: To evaluate the reliability and comparability of a Scheimpflug-based tomographer relative to a Placido-based topographer and specular microscopy in healthy eyes. METHODS: This cross-sectional study included 40 patients (80 eyes). Each eye underwent randomized imaging with a Scheimpflug-based tomographer, a Placido-based topographer, and Tomey EM-4000 specular microscopy. Three acquisitions per device were obtained. For interdevice comparisons, the best-quality scan per eye/device was selected, whereas all three scans were used for intradevice repeatability analyses. Unreliable scans were repeated (up to five attempts) and excluded if acceptable quality was not achieved, resulting in variable denominators. Between-device comparisons were performed using generalized estimating equations with participant-level clustering and robust standard errors and were supplemented by Bland-Altman analysis. RESULTS: The effective sample size varied by parameter (independent summaries: 59-67 eyes; paired comparisons: 48-51 eyes). In paired-eye analyses, the Scheimpflug-based tomographer measured slightly higher keratometry values than the Placido-based topographer (K1: 43.95 vs. 43.78 D, p=0.003; K2: 44.91 vs 44.73 D, p=0.002), more negative Q-values (p=0.001), smaller photopic pupil diameter (p<0.001), and shorter kappa distance (p<0.001). Mean absolute differences were 0.32 D for K1 and 0.30 D for K2, with high dispersion for angular metrics (kappa angle coefficient of variation: 195%). CONCLUSIONS: The Scheimpflug-based tomographer provides reproducible corneal measurements in healthy eyes. However, systematic differences relative to the Placido-based topographer-particularly for keratometry, asphericity, and pupil and kappa metrics-suggest limited interchangeability. Consistent device use is recommended when these parameters inform clinical decision-making.
Barriers to diabetic retinopathy screening in public healthcare in northeastern Brazil.
Santos MLD, Florêncio LBS, Almeida LRB … +8 more , Zwecker LJ, Alves M, Carvalho AB, Nascimento DMD, Bahia L, Schaan BD, Melo GB, Malerbi FK
Arq Bras Oftalmol · 2026 · PMID 42207101 · Publisher ↗
PURPOSE: This study aimed to identify barriers to diabetic retinopathy screening among a socioeconomically vulnerable urban population in northeast Brazil. METHODS: A cross-sectional study was conducted during a diabetic...
PURPOSE: This study aimed to identify barriers to diabetic retinopathy screening among a socioeconomically vulnerable urban population in northeast Brazil. METHODS: A cross-sectional study was conducted during a diabetic retinopathy screening campaign at primary healthcare units. Ninety-five patients with diabetes underwent retinal examinations and completed a structured interview. Clinical, demographic, and socioeconomic data were collected. RESULTS: The study population consisted predominantly of older adults (mean age: 60.7 ± 10.5 years), with a high prevalence of type 2 diabetes (99.0%) and low educational attainment. Most participants were economically inactive (81.1%) and reported low income (83.2%). Diabetic retinopathy and maculopathy were highly prevalent, affecting 50.0% and 22.9% of participants, respectively. Longer duration of diabetes was significantly associated with greater awareness of diabetic retinopathy (p=0.035), higher HbA1c levels (p<0.001), and increased prevalence of diabetic retinopathy (p=0.013) and maculopathy (p=0.002). Notably, 33.3% of participants reported difficulties attending medical appointments for diabetes management. In addition, 78.1% experienced challenges scheduling ophthalmologic evaluations, and 76.3% reported that no ophthalmologist was available in their city through the public healthcare system. Financial constraints also limited adherence to recommended dietary practices (90.4%) and impaired glycemic control, with more than half of participants reporting difficulty maintaining target glucose levels. CONCLUSION: Major barriers to diabetic retinopathy screening included limited awareness of the importance of screening, financial hardship, and transportation challenges. Targeted educational initiatives and structural interventions such as expanded screening programs incorporating telemedicine and subsidized transportation-may improve screening adherence among vulnerable populations.
Repeat selective laser trabeculoplasty in glaucoma and ocular hypertension: a review of efficacy and safety.
Guedes GB, Prata TS, Chavez MP … +1 more , Paranhos A
Arq Bras Oftalmol · 2026 · PMID 42207100 · Publisher ↗
Repeat selective laser trabeculoplasty has emerged as a valuable option for managing intraocular pressure in pa-tients with primary open-angle glaucoma or ocular hypertension. This review synthesizes current evidence of...
Repeat selective laser trabeculoplasty has emerged as a valuable option for managing intraocular pressure in pa-tients with primary open-angle glaucoma or ocular hypertension. This review synthesizes current evidence of the efficacy, safety, and clinical applicability of repeat selective laser trabeculoplasty. Evidence from randomized controlled trials, systematic reviews, and observational studies indicate that repeat selective laser trabeculoplasty effectively sustains significant intraocular pressure reduction with minimal complications. This procedure demonstrates comparable efficacy to that of initial selective laser trabeculoplasty, supporting its role as a sustainable, drop-free management strategy. However, further research is warranted to optimize treatment intervals, assess long-term outcomes, and evaluate cost-effectiveness across different healthcare settings.
Topical losartan in the treatment of corneal injuries: a systematic review.
Cyrino LG, Nascimento LM, Fujimura AY … +5 more , Ribeiro VEA, Castro CEDR, Amaral DC, Guedes J, Sampaio LMMPP
Arq Bras Oftalmol · 2026 · PMID 42207099 · Publisher ↗
This study aimed to evaluate the efficacy and safety of topical losartan for treating corneal injuries and stromal fibrosis based on preclinical and clinical evidence. A systematic search was conducted in October 2024 fo...
This study aimed to evaluate the efficacy and safety of topical losartan for treating corneal injuries and stromal fibrosis based on preclinical and clinical evidence. A systematic search was conducted in October 2024 following PRISMA guidelines across Embase, PubMed, Web of Science, and the Cochrane Library. Studies assessing topical losartan use in animal models or human patients with corneal injury were included. No randomized clinical trials were identified. Of 750 articles screened, 12 met the inclusion criteria - seven preclinical studies and five case reports. Preclinical evidence indicated that topical losartan at 0.2-0.8 mg/dL reduced stromal opacity and myofibroblast differentiation. Higher concentrations (8-80 mg/dL) offered no additional benefit and were associated with ocular surface irritation. The five case reports included 11 patients (12 eyes); eight eyes showed visual improvement, and no adverse effects were observed at a dose of 0.8 mg/dL. Topical losartan demonstrates potential as an antifibrotic agent for corneal injuries. However, variability in outcomes and dose-related toxicity at higher concentrations highlight the need for controlled clinical trials to confirm efficacy, establish optimal dosing, and ensure safety.
Brazil among the world's most cited researchers: Significance, methods, and the place of Ophthalmology.
Santhiago MR
Arq Bras Oftalmol · 2026 · PMID 41810659 · Publisher ↗
Abstract loading — click title to view on PubMed.
The artificial intelligence revolution in medical education.
Kara-Junior N, Morinaga CV, Machado DG
Arq Bras Oftalmol · 2026 · PMID 41810658 · Publisher ↗
Abstract loading — click title to view on PubMed.
Evaluation of the pachychoroid spectrum in patients with mild autonomous cortisol secretion.
Kan EK, Kan E, Eraydin B … +2 more , Gündüz B, Yucel OE
Arq Bras Oftalmol · 2026 · PMID 41810657 · Publisher ↗
PURPOSE: To investigate choroidal structural and vascular changes in patients with mild autonomous cortisol secretion using enhanced depth imaging optical coherence tomography and optical coherence tomography angiography...
PURPOSE: To investigate choroidal structural and vascular changes in patients with mild autonomous cortisol secretion using enhanced depth imaging optical coherence tomography and optical coherence tomography angiography. METHODS: This cross-sectional study included 60 eyes of 30 patients with mild autonomous cortisol secretion and 60 eyes of 30 subjects with nonfunctional adenoma (controls) between February 2023 and January 2024. Subfoveal choroidal thickness, pachychoroid spectrum disease and choroidal vascularity index were evaluated using spectral-domain optical coherence tomography. Group comparisons were performed, and correlations between subfoveal choroidal thickness and clinical features were analyzed. RESULTS: Pachyvessels were more common in patients with mild autonomous cortisol secretion than in controls (71.4% vs. 42.9%, p=0.002). The frequency of pachychoroidal spectrum disease was significantly higher in the mild autonomous cortisol secretion Group (68.3% vs. 31.7%; p<0.001). Median subfoveal choroidal thickness was 355 μm (range, 150-535) in the mild autonomous cortisol secretion Group and 297 μm (range, 162-597) in controls (p=0.014). Choroidal vascularity index was comparable between groups (p=0.072). Subfoveal choroidal thickness correlated significantly with axial length, spherical equivalent, post-1-mg dexamethasone suppression test cortisol level, and disease duration. CONCLUSION: Patients with mild autonomous cortisol secretion exhibited greater subfoveal choroidal thickness and a higher frequency of pachychoroidal spectrum disease compared with controls, whereas stromal and vascular structural alterations were proportionally similar between groups.
Effect of a propylene-glycol-hydroxypropyl guar nanoemulsion on symptoms and ocular surface parameters in patients with evaporative dry eye.
Cartes C, Zapata C, Lopez C … +3 more , Gaete C, Aguilera N, Segovia C
Arq Bras Oftalmol · 2026 · PMID 41810656 · Publisher ↗
PURPOSE: To evaluate the effects of a propylene glycol-hydroxypropyl guar nanoemulsion on symptoms and ocular surface parameters in patients with evaporative dry eye. METHODS: This prospective, single-center, interventio...
PURPOSE: To evaluate the effects of a propylene glycol-hydroxypropyl guar nanoemulsion on symptoms and ocular surface parameters in patients with evaporative dry eye. METHODS: This prospective, single-center, interventional study included patients aged 18-50 years with evaporative dry eye who received a propylene glycol-hydroxypropyl guar nanoemulsion. Participants were instructed to instill the nanoemulsion three times daily for 90 days. Evaluations included the Ocular Surface Disease Index, tear osmolarity, tear meniscus height, lipid layer thickness, noninvasive tear break-up time, fluorescein tear break-up time, corneal fluorescein staining (National Eye Institute Scale), Schirmer's test I, and meibum quality. RESULTS: Thirty-three participants were enrolled, and 30 completed the study. The mean age was 36 ± 10 yr, and 73.3% were women. The mean Ocular Surface Disease Index score significantly decreased from 43.1 ± 20 at baseline to 25.2 ± 17 at 3 months (p=0.009). Median corneal fluorescein staining decreased from 2 (IQ range=1-3) to 1 (IQ range 25-75 = 0-1) at the final follow-up (p=0.002). The mean fluorescein tear break-up time increased significantly increased from 3.8 ± 2.1 at baseline to 5.8 ± 2.2 at 3 months (p=0.002). Tear osmolarity decreased significantly (p=0.01) and lipid layer thickness improved markedly (p<0.001). No significant changes were observed in tear meniscus height or noninvasive tear break-up time (p>0.05). CONCLUSIONS: Treatment with a propylene glycol-hydroxypropyl guar nanoemulsion significantly improved dry-eye symptoms, corneal staining, tear film stability, and lipid layer quality in patients with evaporative dry eye. No adverse events were reported, supporting the safety and efficacy of this formulation.
Quantitative assessment of tear film function and meibomian gland morphology in newly diagnosed atopic dermatitis.
Gündogan AO, Oltulu R, Belviranli S … +3 more , Tezcan A, Temiz SA, Altay E
Arq Bras Oftalmol · 2026 · PMID 41810642 · Publisher ↗
PURPOSE: This study aimed to analyze ocular sur-face parameters and evaluate meibomian gland dys-function using meibography in newly diagnosed patients with atopic dermatitis compared with healthy controls. METHODS: This...
PURPOSE: This study aimed to analyze ocular sur-face parameters and evaluate meibomian gland dys-function using meibography in newly diagnosed patients with atopic dermatitis compared with healthy controls. METHODS: This cross-sectional clinical study included 51 newly diagnosed patients with atopic dermatitis and 45 ageand sex-matched healthy controls. Disease severity was assessed using the Eczema Area Severity Index. The Ocular Surface Disease Index questionnaire, Schirmer test, tear meniscus height, noninvasive tear break-up time, conjunctival redness grading, and meibography staging were performed. Meibomian gland dropout was graded for each eyelid from 0 (no loss) to 3 (loss of >2/3 of the total gland area). RESULTS: Schirmer test values, tear meniscus height, and noninvasive tear break-up time were significantly lower in the atopic dermatitis group than in the control group (p<0.001, p<0.001, and p<0.001, respectively). In contrast, Ocular Surface Disease Index scores, conjunctival redness grades, and total meiboscores were significantly higher in the atopic dermatitis group than in the control group (p<0.001, p<0.001, and p<0.001, respectively). Moreover, in the atopic dermatitis group, a significant positive correlation was observed between the Eczema Area Severity Index score and total meiboscore (rₛ=0.390, p=0.005), while a significant negative correlation was found between the Eczema Area Severity Index score and Schirmer test results (rₛ=-0.301, p=0.032). CONCLUSIONS: Newly diagnosed patients with atopic dermatitis exhibit significant alterations in tear film parameters and meibomian gland morphology compared with healthy individuals. These patients should be monitored for early development of dry eye disease and meibomian gland dysfunction to prevent associated complications.
Evaluation of autonomic dysfunction with dynamic pupillometry in non-obese young women with polycystic ovary syndrome.
Gündogan K, Gündogan AO, Demir ET … +1 more , Tora N
Arq Bras Oftalmol · 2026 · PMID 41810641 · Publisher ↗
PURPOSE: Polycystic ovary syndrome is frequently associated with autonomic nervous system dysfunction, even in the absence of obesity or overt metabolic abnormalities. Alterations in pupillary responses may reflect early...
PURPOSE: Polycystic ovary syndrome is frequently associated with autonomic nervous system dysfunction, even in the absence of obesity or overt metabolic abnormalities. Alterations in pupillary responses may reflect early autonomic involvement and serve as a potential tool for early diagnosis, risk stratification, and disease monitoring. This study aimed to investigate pupillary reflex parameters using dynamic pupillometry in newly diagnosed non-obese women with polycystic ovary syndrome and to compare the findings with those of healthy controls. METHODS: This prospective cross-sectional study included 48 newly diagnosed women with polycystic ovary syndrome and 44 ageand sex-matched healthy controls. Pupillary function parameters were measured using dynamic pupillometry (MonPackOne; Metrovision, France). RESULTS: The mean age did not differ significantly between the groups (p=0.870). Initial pupil diameter, pupil contraction amplitude, and contraction velocity were significantly lower in the PCOS group than in the control group, whereas pupillary dilation duration was significantly longer (p<0.001, p<0.001, p=0.007, and p=0.032, respectively). No significant differences were observed between the groups regarding contraction latency, contraction duration, dilation latency, or dilation velocity (p=0.749, p=0.925, p=0.653, and p=0.310, respectively). CONCLUSION: Newly diagnosed non-obese women with polycystic ovary syndrome exhibit significant alterations in pupillary dynamics, suggesting a generalized reduction in both sympathetic and parasympathetic activity. Dynamic pupillometry may represent a practical, noninvasive tool for detecting early autonomic hypoactivity and identifying patients at risk for future metabolic or cardiovascular complications.
The role of meibomian gland morphological alterations in the development of dry eye disease in type 2 diabetes.
Ekin MA
Arq Bras Oftalmol · 2026 · PMID 41810640 · Publisher ↗
PURPOSE: To evaluate whether specific meibomian gland morphological features can serve as diagnostic indicators of dry eye disease in patients with type 2 diabetes mellitus. METHODS: This cross-sectional study included p...
PURPOSE: To evaluate whether specific meibomian gland morphological features can serve as diagnostic indicators of dry eye disease in patients with type 2 diabetes mellitus. METHODS: This cross-sectional study included patients with type 2 diabetes mellitus and age-matched healthy controls. All participants underwent a comprehensive ocular surface evaluation, including the ocular surface disease index, tear break-up time, Schirmer's I test, corneal staining, eyelid margin scoring, meibum expressibility assessment, meibography scoring, and evaluation of meibomian gland loss area. Meibomian gland morphology was assessed bilaterally. Dry eye severity was determined based on ocular surface disease index scores, tear break-up time, Schirmer's test results, and corneal staining scores. Correlations between meibomian gland features and ocular surface parameters, age, diabetes duration, and hemoglobin A1c levels were analyzed. Receiver operating characteristic analysis was performed to determine the diagnostic value of specific meibomian gland features for dry eye disease. RESULTS: Dry eye disease was diagnosed in 56.6% of patients with diabetes and 22.6% of controls. Compared with controls, patients with diabetes had significantly higher ocular surface disease index scores, greater corneal staining, worse meibum expressibility, increased meibomian gland loss, and lower tear break-up time and Schirmer values (all p<0.05). Meibomian gland dropout, shortening, tortuosity, distortion, overlapping, ghost glands, and lack of extension to the lid margin were significantly more prevalent in patients with diabetes (p<0.05) and showed significant correlations with age, HbA1c levels, and diabetes mellitus duration. Receiver operating characteristic analysis identified meibomian gland dropout, ghost glands, shortening, and lack of extension to the lid margin as the most predictive morphological features for dry eye disease in patients with diabetes. CONCLUSION: Type 2 diabetes mellitus is associated with distinct meibomian gland morphological alterations that correlate with both dry eye disease severity and systemic diabetic parameters, suggesting potential diagnostic value.
Alumni in Focus: Profile, scientific production, and career of graduates from the postgraduate program in ophthalmology at UNIFESP.
Demetrio R, Faneli AC, Freitas D … +1 more , Regatieri CVS
Arq Bras Oftalmol · 2026 · PMID 41810639 · Publisher ↗
PURPOSE: To evaluate the academic and professional trajectories of graduates from the Graduate Program in Ophthalmology and Visual Sciences at the Escola Paulista de Medicina, Universidade Federal de São Paulo, including...
PURPOSE: To evaluate the academic and professional trajectories of graduates from the Graduate Program in Ophthalmology and Visual Sciences at the Escola Paulista de Medicina, Universidade Federal de São Paulo, including geographic distribution, occupational characteristics, and scientific productivity. METHODS: This descriptive, retrospective, quantitative study included 498 alumni who completed the program between 1979 and 2021. Data were obtained from institutional records and supplemented by public databases (Google Scholar, Lattes Platform, and LinkedIn). The analyzed variables included demographic characteristics, academic background, current professional role, and bibliometric indicators (citation count and h-index). Statistical analyses comprised nonparametric tests and linear regression, with a significance level set at 5%. RESULTS: Most alumni were Brazilian (96.6%) and physicians (90.7%), predominantly located in the Southeast region (66.9%). Doctoral training was completed by 80.5% of participants. Alumni with current institutional ties to Universidade Federal de São Paulo or Hospital São Paulo demonstrated significantly higher citation counts and h-index values. No significant correlation was observed between time since graduation and citation count (p=0.185). Alumni engaged in academic roles or with postdoctoral training showed greater scientific productivity. CONCLUSIONS: The findings highlight the strong academic performance and professional integration of alumni from Universidade Federal de São Paulo, particularly within public institutions and the Southeast region of Brazil. Doctoral training and institutional affiliation were associated with higher scientific productivity. Alumni tracking provides valuable insights into the impact of postgraduate programs and informs strategic planning and development.
Evaluation of intrastromal micropuncture in Eye Bank corneas using a tattoo machine.
Farah ML, Arbache S, Belfort R
Arq Bras Oftalmol · 2026 · PMID 41810638 · Publisher ↗
PURPOSE: To assess the reliability and penetration depth of an automated micropuncture system using a tattoo machine. METHODS: Twenty human corneas were obtained and subjected to intrastromal micropuncture using a tattoo...
PURPOSE: To assess the reliability and penetration depth of an automated micropuncture system using a tattoo machine. METHODS: Twenty human corneas were obtained and subjected to intrastromal micropuncture using a tattoo machine. Each cornea was divided into two halves: one received pigment, while the other received saline solution as a control. The Cheyenne tattoo machine was operated at 60 Hz, with standardized needle exposure (six passes per application). The machine used cartridges containing five microneedles. The study was registered with Agência Nacional de Vigilância Sanitária ANVISA (numbers 80281110015, 80281110016, and 80281110019). The pigment used was Electric Ink black ink, with a density of 1,271,460 μg/mL. Puncture depth was measured before and after the procedure using both anterior segment optical coherence tomography and histopathological analysis. Puncture depth measurements were analyzed using ImageJ software. Each cornea was measured thrice, and the results were subsequently compared. RESULTS: No corneal perforations were observed with the use of the tattoo machine, and puncture depth measurements ranged from 107 to 486 μm. CONCLUSIONS: The use of a tattoo machine represents a viable and accessible approach for keratopigmentation, with potential for both cosmetic and therapeutic applications. Its adaptation for controlled intrastromal drug delivery may enable the targeted treatment of deep infectious keratitis, corneal neovascularization, and stromal inflammatory disorders, representing a promising approach for corneal stromal diseases. Further research is needed to optimize techniques and evaluate long-term safety and efficacy, particularly for the delivery of antimicrobial, anti-inflammatory, and anti-vascular endothelial growth factor agents.
Structural analysis of amniotic membrane for use in ophthalmology with different preservation techniques.
Santos CC, Abud RTB, Shiguematsu AI … +1 more , Santos DCD
Arq Bras Oftalmol · 2026 · PMID 41810637 · Publisher ↗
PURPOSE: To evaluate structural differences in amniotic membrane fragments subjected to different preservation techniques for potential ophthalmologic applications. METHODS: Three placentas were collected from healthy do...
PURPOSE: To evaluate structural differences in amniotic membrane fragments subjected to different preservation techniques for potential ophthalmologic applications. METHODS: Three placentas were collected from healthy donors, and four amniotic membrane fragments were prepared from each placenta. The fragments were divided into four groups with three samples each: cryopreserved, lyophilized, vacuum--dried using a vacuum concentrator, and fresh (control). After processing, the fragments were fixed, sectioned, and analyzed using scanning transmission electron microscopy to assess tissue morphology. RESULTS: All samples met the established evaluation criteria. No morphological differences were observed among the groups. The structural characteristics of lyophilized and vacuum-dried membranes were comparable with those of cryopreserved and fresh membranes. However, vacuum drying demonstrated the greatest practicality for ophthalmologic use, as it allows membrane availability at any time and storage at room temperature. CONCLUSION: Vacuum drying using a vacuum concentrator, lyophilization, and cryopreservation preserve the morphological characteristics of the human amniotic membrane similar to those of fresh tissue. A standardized protocol using a vacuum concentrator may be established owing to its advantages in storage convenience and accessibility.
A trilogy of the oculomotor system Part II - active, passive, and dissipative forces Part III - diagnostic tests.
Bicas HEA
Arq Bras Oftalmol · 2026 · PMID 41779496 · Publisher ↗
In Part II, this paper addresses ocular motions, their causes (forces), and the governing laws, beginning with the fundamental question: Why do the eyes move? Ocular rotations and different types of translations (ocular,...
In Part II, this paper addresses ocular motions, their causes (forces), and the governing laws, beginning with the fundamental question: Why do the eyes move? Ocular rotations and different types of translations (ocular, orbital, and corporeal) are reviewed. The discussion then turns to how the eyes move, where concepts such as the plane of muscular action, torque, and arc of contact provide possible explanations for the anatomical arrangement of the ocular muscles within the orbit. Sherrington's law of reciprocal innervation is used to explain the distribution of muscular active forces in a conservative mechanical system, but in combination with Hering's law, it may prevent eye rotation (e.g., isometric contractions of antagonist muscles of an asymmetrical convergence). Normally, however, the limitation of an eye rotation is determined by passive forces, evoked by muscular activity itself, particularly natural muscular elasticity. Thus, elongation of an antagonist muscle may passively restrict the active contraction of an agonist. In addition to mechanisms for initiating rotation (active forces) and stopping it (passive forces), the oculomotor system also requires a means of dissipating energy (dissipative forces) to initiate subsequent movements. Hence, it cannot function as a perfectly conservative system of forces. The paper concludes with a review of "selective" effects of muscle function (due to the sparse distribution of fibers), the role of intermuscular membranes (and pulleys), and mechanical considerations of surgical procedures, such as muscular transpositions to alter or abolish actions (e.g., bifid reinsertions). Part III will address the diagnostic complexities of the oculomotor system, general treatment principles, and ocular fixation (eye and head positions). Although the basic concept of the primary position is relativized, the absolute need for referential conditions in defining, qualifying, and measuring strabismus is emphasized. The prim-diopter is challenged due to its lack of "linearity" relative to angular units, and an alternative is proposed. Methods of examining oculomotor disturbances are outlined, including monocular rotations (ductions), and tests to differentiate between muscular deficiencies and opposing forces. Techniques for identifying the site of a rotational restriction are described, followed by approaches to measuring ocular deviations in diagnostic positions. The concepts of muscular overactions and underactions are analyzed before introducing the concept of diagnostic muscle pairs. Classical knowledge about deviations caused by deficient or restricted muscle actions reinforces the theory of distribution of rotational ocular muscles by diagnostic pairs. For vertical deviations, "underactive" muscle pairs must be separately matched (e.g., RSR with LIR, RIO with LSO). Since vertical recti exert stronger vertical actions than oblique muscles, head tilts are recommended to enhance stress on both pairs, mainly by additional stimulation of oblique muscles. Classical diagnostic directions then align with the objective horizontal plane. The article concludes with peropertative oculomotor testing and a broad protocol for evaluating oculomotor imbalance.
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